Ultrasonic cauterization

ABSTRACT

The method and apparatus of the invention use ultrasonic energy in the form of mechanical vibrations transmitted by a tool member to close off small severed blood vessels, such as in humans, by the formation of closures at the terminal portions thereof, and stop what is called &#39;&#39;&#39;&#39;ooze,&#39;&#39;&#39;&#39; that requires constant mopping or cleansing techniques during an operation. This tool member may be in the form of a knife ultrasonically vibrated to simultaneously sever and close off respective terminal portions of the severed blood vessels while performing surgical procedures. The tool member, of a proper configuration, may also join together layers of tissue, including the walls of unsevered blood vessels, and with respect to the latter is foreseen as replacing the &#39;&#39;&#39;&#39;tying off&#39;&#39;&#39;&#39; of arteries and veins currently necessary in surgery.

Zg-ZnA AU 335 EX ---wvuvwulyvfl n'atclll Balamuth 1 Jan. 25, 1972 [54]ULTRASONIC CAUTERIZATION 2,730,103 l/l956 Mackta 128/305 2,888,9286/1959 Seiger ..l28/303.17 [72] Balammh New 3,058,470 10/1962 Seeligeret al..... ..128/303.l7 x [73] Assignee: Ultrasonic Systems, Inc.,Farmingdale, 3,086,288 4/1963 Balamuth et a1. ..l28/305 UX NY. 3,308,0033/1967 Deans v.128/305 X [22] Filed on. 27 1967 3,433,226 3/1969 Boyd..128/3O5 [21] App]. No.: 678,649 Primary Examiner-Richard C. PinkhamAssistant Examiner-Richard J Apley An -L d W. S ff 52 us. c1. ..l28/24A, 128/303.17. 128/305, omey 156/73 57 ABSTRACT [51] Int. Cl...A6lb17/36, A61b 17/32, A61h 23/00, l [58] Field ofSeaT-ch..128/2.1,24.05,30313-30319, The method and pp us of t e n ention useultrasonic 123/305, 24 156/73 energy in the form of mechanicalvibrations transmitted by a I tool member to close off small severedblood vessels, such as [56] Rd Cit d in humans, by the formation ofclosures at the terminal portions thereof, and stop what is calledooze," that requires UNITED STATES PATENTS constant mopping or cleansingtechniques during an opera- 2 985 954 5/1961 Jones at al 156/73 UX tion.This tool member may be in the form ofa knife ultrasonil4 2/1962 BodineJr 156/73 cally vibrated to simultaneously sever and close offrespective 3l84354 5/1965 Stwthe'r "156/73 terminal portions of thesevered blood vessels while perform- 3l93'424 7/965 Scott ing surgicalprocedures. The tool member, of a proper con- 3'49'447 12/1968 "56/73figuration, may alsojoin together layers of tissue, including l586'6456/1926 17 the walls of unsevered blood vessels, and with respect to thel'sslzso 10/1932 Tomlinso; "us/303' latter is foreseen as replacing thetying off" of arterres and 2:714:890 8/1955 Vang.3................::::.....128/305 "einscummly necessary in PE AK TOOL-20 Claims, 29 Drawing Figures VELOCITY FREQUENCY OF 2. MECHANICALVIBRATION VIBRATION ENERGY PRESSURE ABSORPTION 3. APPLIED WITH IN TISSUETOOL T1$5UE 4- TOOL WORKING CLOSURE SURFACE on 301mm.

5 currme EDGE FRICTIONAL Ruaamo TOOL HEAT 6 TEMPERATURE 1 DEVELOPMENT INT1ssuE 7 OXYGEN FOR CLOTTlNG PATENTED JMSWZ 3.636.943

SHEET 1 OF 5 PEAK TOOL VELOCITY FREQUENCY OF MECHANICAL VIBRA 0NVIBRATION ENERGY PRESSURE ABSORPTION APPLIED WITH T'SSUE TOOL TOOLWORKING T'SSUE c osu SURFACE L RE 0R JOINING CUTTING EDGE E- .E.h

FRICTIONAL RUBBING TOOL C op T TEMPERATURE DE IN TISSUE OXYGEN FOR CLOTTING LEWIS EA LI- MIJH PATENIED JANZS I972 F/G.3 B

SHEET 3 OF 5 28a wawzsa PATENTEDJANZSEII'Z 3.636.943

saw u or 5 FIG. 6 62! 564 25 1 LEWIS BALMMT,

HY W MM ULTRASONIC CAUTERIZATION BACKGROUND AND SUMMARY OF THE INVENTIONThe present invention relates generally to improvements in surgicalprocedures whereby ultrasonic energy is utilized and more particularlyto methods and apparatus for closing off the terminal portions ofsevered blood vessels to stop or prevent the flow of blood therefromduring the surgical procedure and the joining of layers of tissue inbiological organisms such as humans.

The outstanding and unexpected results obtained by the.

practice of the method and apparatus of the present invention, areattained by a series of features, steps and elements, working togetherin interrelated combination, and may be applied to biological organismsin general and particularly humans, and hence will be so illustrated anddescribed with respect to humans. 7

Applicant has already participated in earlier developments which led toUS. Pat. No. 3,086,288 covering the use of an ultrasonically vibratingscalpel or knife. The aim of that invention was to increase the easewith which a surgical knife could be used to cut organic tissues.

We are concerned in the present invention with new discoveries byapplicant which allow dramatic improvements in the operation ofhigh-frequency vibrated knives, and also extend the use of the side areaor working surface of a knife to perform a useful function, especiallyin relation to preventing or stopping bleeding.

Before proceeding to the details of the invention, let us first reviewbriefly generally known facts of bleeding. The blood or circulatorysystem of the body (for warm blooded animals and humans) is comprised oftwo great and complex systems of arteries and veins. The arteries carryblood from the heart and these arteries divide in a complex network ofsmaller arteries or arterials, which in their turn connect to anextraordinarily complex network of very fine blood carrying tubes calledcapillaries. These capillaries are in communication with all the cellsof the body and they provide the nutrients needed to feed these cellsand they also supply the white blood cells needed to dispose of wastesand, in general, to police the cells and their environment in respect tounwanted substances and agents. After doing their job, the blood cellsfind their way back to the heart by means of a similar network ofcapillaries which join up to veinules or small veins, which in turnconnect to veins which ultimately bring the blood back to the heart.There is also a lymph system which participates in this process, whereinagain small tubes containing lymph (a kind of blood plasma with whitecorpuscles and waste products) convey this lymph through variousstrainers called lymph nodes and then, ultimately by means of thethoracic duct the purified lymph flow back into a large vein in theneck.

Now when the body is cut into at any location, in general a number ofthe tubes or vessels carrying blood are severed in this region. Thisseverance will include many capillaries, some small veins and arteriesand in some cases even a regular artery or a vein or both. Thecapillaries comprise an area which is as much as 100,000 times the areaof the arteries and veins, and thus it is seen that many morecapillaries are involved per incision than any other vessels. Thesevering of capillaries produces an ooze of blood which must be moppedup or swabbed during an operation, while the larger blood vesselsinvolved must be clamped or tied off to prevent bleeding during thesurgery. The attending of these bleeding problems takes up about 67percent of the time of most operations. it is a major aim of thisinvention to reduce this lost time considerably and at the same time toreduce the total loss of blood and to promote the healing of the woundscreated. This is accomplished by the design of ultrasonic instruments soas to enhance those uses of ultrasonic energy needed to accelerate thedesired objective, namely to stop bleeding.

Ordinarily, bleeding stops by virtue of the interaction between smallbodies in the blood stream called platelets and the oxygen in the air,whereby the platelets disintegrate and form a network of fibers calledfibrin which slow up and finally stop the blood flow by the formation ofsuitable clots. Heat may be used to accelerate this process, and in factboth electric cautery and hot wire cautery 'are used in controllingbleeding in some procedures. But these types of cautery produce, inaddition to rapid clotting, an extensive destruction to all tissue,thereby requiring a long time in the healing. By means of ultrasonicenergy it is possible to promote the clotting with far less damage, aswill be disclosed herein, so that bleeding may be very quickly haltedand at the same time, much quicker healing will take place.

Electric and hot-wire cautery as well as cryogenic techniques are noteffective for the care of bleeding from veins and arteries and it ishere that special tying-off methods or he tatic clamping techniques areused. lt is a further aim of this invention to teach how tying-off andclamping techniques may be replaced by utilizing ultrasonic energy inthe proper way.

In all the ways whereby ultrasonic energy is used in this invention, thetool member supplying the energy executes vibrations of high frequencyand small amplitude. Since the development of the ultrasonic knife, inpart by present applicant, new alloys have become generally availablewhich permit the maximum amplitude of vibration at a given frequency tobe increased substantially. For example, in regular use a scalpel couldbe vibrated at 20 kc./sec. with a stroke of two to at most fourthousandths of an inch. A larger stroke would cause a rapid fatiguefailure of the ultrasonic motor driving the scalpel. With a new alloy oftitanium (titanium with 6Al-4V is one such) it is possible to go tostrokes as high as 8 or l0 thousandths of an inch. This means that therubbing action of a single stroke may be greatly enhanced, because thepeak velocity achieved during the stroke is more than double the peakvelocities previously attainable on a practical basis.

This improvement led applicant into the development of procedures andtools whereby such large ultrasonic motions could be put to work to stopcapillary bleeding while cutting the surrounding tissue. In order tounderstand this, let us consider the transfer of energy which occursduring cutting. Wherever the tissue comes into contact with the cuttingtool or scalpel, the tool member is moving to and fro at high frequencyparallel to the surface of the tissue being severed. To the extent thatthere is good acoustic coupling between tissue and tool, there will be atransfer of shear waves into the tissue. But, tissue is of an acousticnature as to be practically incapable of supporting high-frequency shearwaves. Therefore, the shear waves damp out very rapidly and dissipatetheir energy in the superficial tissue as heat. This promotes fibrinformation and clotting at the capillaries, while the damage tounderlying tissue is minimal due to lack of penetration of this clottingenergy. To the extent that the tool slips past the tissue during its toand fro motion, a rubbing action is set up, due to relative motion oftool and tissue and a frictional heat is generated at the tool tissueinterface, again producing a heating and clotting action on the adjacentterminal portion of the opened capillaries and other blood vessels.Thus, entirely due to the ultrasonic to and fro motion of the tool, acooperative dual effect is engendered whereby the ooze" during anoperation is efiectively stopped while cutting.

Applicant has further found that the peak rubbing speed, which equalsrrfx the peak to-and-fro stroke (f= frequency of tool) is relativelyconstant with respect to frequency. This is because the peak strain setup in the ultrasonic motor driving the cutting tool depends directly onthe peak speed of the cutting tool and not on the peak frequency. Ofcourse, this merely means that if one wishes to operate at a higherfrequency, then one has to be content with a proportionately I used toactually sever the tissue itself. This latter component of energy isonly a small fraction of the tool energy used.

In actual practice, applicant has discovered that, by texturing orroughening the sidewalls of the cutting tool, the transfer ofsuperficial cauterizing energy is increased so as such for certainsurgical procedures it is preferable to use scalpels whose workingsurfaces or side faces are roughened rather than very smooth. The sameprinciple applies to spatulate tools wherein no cutting is contemplated,but the tool is designed primarily to cauterize an already opened bed ofblood vessels such as capillaries in a wound. In the case of thespatulate tool the amount of energy transfer may be increased bypressing the spatula tool working surface, while vibrating, withincreased pressure against the wound to apply a compressive force forthe transmission of the shear waves or increasing the frictionalrubbing. Applicant has also discovered, that although it is notessential, it is nevertheless desirable to supply the cutting edge of aknife or scalpel with a set of small serrations. This further aids inclotting, and permits faster artery by clamping it in a speciallydesigned ultrasonic instrument, so that the walls of said blood vesselare briefly clamped while vibrating one or both of the tool jaws. Sincethis same principle applies to other soft body tissue such as the skin,this same type of tool may be used in place of the conventional suturingwhich is used in closing incisions in surgical procedures.

Thus, it may be seen that we are dealing with a highly complicated setof phenomena in practicing applicants method of bloodless surgery. Atthis time, it is not known quantitatively just how large a role isplayed by each factor, such as shear wave absorption, frictional heatproduction and tissue sealing. The point is that by employing ultrasonicmotors capable of producing generally higher strokes than previouslyavailable, the combination of effects permits for the first time, truebloodless surgical procedure by ultrasonic means. Where extremely fastprocedures are essential, one may also resort to auxiliary heating ofthe vibrating tool member, but only to subcautery temperatures. Thistemperature is preferably above room temperature but below a temperaturethat would normally burn the tissue. This may be accomplishedconventionally, or in accordance with the method disclosed in U.S. Pat.No. 3,321,558 in which applicant is a coinventor.

OBJECTIVES OF THE INVENTION An object of the present invention is toprovide an improved method and apparatus for forming surgical procedureswith ultrasonic energy.

Another object of the present invention is to provide an improved methodand apparatus for securing together layers of tissue in biologicalorganisms, such as humans.

Yet another object of the present invention is to provide an improvedmethod and apparatus for forming closures at the severed terminalportions of blood vessels in vivo, which blood vessels are in thegeneral neighborhood of what are called capillaries, so as to prevent"ooze, which requires contact mopping or cleansing during surgicaloperations.

A further object of the present invention is to provide improved methodand apparatus for permanently or temporarily closing off blood vesselsso as to replace the tying off" of arteries and veins currentlynecessary in surgery.

Still another object of the present invention is to provide a method andapparatus of bloodless surgery which combines the surgical cutting oftissue and a closing off of the severed blood vessels to prevent the"ooze" normally associated with operations.

Yet still another object of the present invention is to provide a methodand apparatus for simultaneously joining and trimming, as by cutting, alarge blood vessel.

Yet still a further object of the present invention is to provide animproved method and apparatus for ultrasonically joining together layersof tissue.

Still a further object of the present invention is to provide animproved method and apparatus for increasing the flow of oxygen to theterminal portion of the severed blood vessel to expedite the clotting ofthe blood thereat.

Still yet a further object of the present invention is to provide animproved sealing apparatus for joining together layers of human tissue.

Still yet a further object of the present invention is to providespecially designed tools adapted to be ultrasonically vibrated andemployed in surgical procedures.

Other objects and advantages of this invention will become apparent asthe disclosure proceeds.

BRIEF DESCRIPTION OF THE DRAWINGS Although the characteristic featuresof this invention will be particularly pointed out in the claims, theinvention itself, and the manner in which it may be made and used, maybe better understood by referring to the following description taken inconnection with the accompanying drawings forming a part hereof, whereinlike reference numerals refer to like parts throughout the several viewsand in which:

FIG. 1 is a chart indicating the relationship of the principal factorsaffecting the practicing of the present invention for surgicalprocedures;

FIG. 2 is an assembled somewhat schematic view of an ultrasonic motorgenerator system of the type in which the motor is capable of being handheld and manipulated, for driving a tool member adapted to engage thebiological organism for performing a surgical procedure, and which inthe present instance the tool member is illustrated as a knife forsevering blood vessels, the latter shown on a greatly enlarged scale fordiscussion purposes;

FIG. 3 is a side view of an ultrasonic tool member having a texturedworking surface in accordance with the present invention;

FIGS. 3A and 3B are end views of the tool member in FIG. 3 andillustrates two preferred ways of obtaining the textured workingsurface;

FIG. 4 is a greatly enlarged schematic representation of a portion of atool member with its working surface in engagement with the terminalportion of a blood vessel for forming a closure thereat to prevent theflow of blood from said terminal portion;

FIG. 4A is an enlarged section view taken along line 4A 4A of FIG. 4 toillustrate the interfacial contact between the tool working surface andblood vessel for the transmission of frictional energy and shear wavesfor localized heating of the terminal portion;

FIG. 4B is a greatly enlarged schematic representation illustrating anultrasonically vibrating tool member engaging a severed portion oftissue for simultaneously forming a plurality of closures at theterminal portions thereof;

FIG. 4C is a greatly enlarged schematic representation illustrating theangular relationship between the tool member and blood vessel whichdefines a terminal plane that may define an extreme angle with the axisof the blood vessel and still obtain the desired results of the presentinvention;

FIG. 4D is an end view of the tool member and blood vessel of FIG. 4C;

FIGS. 5, 5A, 5B and SC are enlarged schematic representations in crosssection of the method of forming a closure at the terminal portion of ablood vessel in which the sidewalls thereof are joined together;

FIG. 5D is an extremely enlarged view of a blood specimen to illustratesome of the important components thereof;

FIGS. 6 and 6A are enlarged schematic representations in cross sectionof the method of forming a closure at the terminal portion of a bloodvessel in which the closure is formed by partially converging thesidewalls thereof and forming a blood clot in the reduced opening;

FIGS. 7 and 7A are enlarged schematic representations in cross sectionof the method of forming a closure at the terminal portion of a bloodvessel in which the closure is formed by primarily forming a blood clotat the terminal portion thereof;

FIGS. 8 and 8A are side and end elevational views respectively, of aspatula tool member having a textured working surface for ultrasoniccautery;

FIG. 9 is an enlarged sectional view illustrating the forming of aplurality of closures on respective terminal portions in an open woundby the use of a spatula-shaped tool;

FlG. 10 is a top longitudinal view, of one preferred form of ultrasonicsystem, of the type capable of being hand held and manipulated, forjoining together layers of tissue, such as in humans;

FlG. 11 is a side longitudinal view, partly in cross section, of theultrasonic system of FlG. l0;

FIG. 12 is an enlarged schematic view, in cross section, illustratingthe application of the ultrasonic instrument illustrated in FIGS; 10 and11 for securing together the walls of a,

DETAILED DISCUSSION OF THE DRAWINGS The high-frequency transducer meansmay be either in the sonic or ultrasonic frequency range but forpurposes of the present invention the word "ultrasonic will be used todenote vibrations in the range of approximately 5,000 to 1 millioncycles per second. ln addition the term blood vessel" as used herein isintended to include any tubular member of the human body, butparticularly ca ilarles, a s, ve' ules, arteries and veins.

ln performing the surgical procedures of the present invention there areseveral factors that have to be taken into consideration and analyzed interms of a total or effective value to obtain the desired end results.The term total value may be defined as the proper combination of thesefactors to obtain the desired end result.

Referring now to the drawings, FIG. 1 is a chart illustrating therelationship of the seven principal factors which are involved in wholeor in part for determining the total value associated with fon'ningclosures at the terminal portions of severed blood vessels, or joiningtogether overlapping segments of layers of human tissue. The relatedfactors are-peak tool velocity, frequency of vibration, pressure appliedwith tool, tool working surface, cutting edge, tool temperature andoxygen for clotting. These factors vary with respect to the procedurebeing performed.

In the embodiments of the invention discussed below the working surfaceof the tool member is placed in engagement with at least one of thelayers of tissue at a surface thereof such that a small compressiveforce is applied in a plane substantially normal to the engaged surface.While this compres: sive force is maintained the working surface of thetool member is vibrated at an ultrasonic rate to apply an additionalenergy producing force at the engaged surface. The compressive andenergy producing forces are continued until the layers of tissue aresecured together by the combined action of these forces.

When these layers of tissue form the walls of blood vessel the forcesare applied to the terminal surface thereof for producing localizedheating in forming a closure to prevent the blood from escapingtherefrom. The energy producing force may be divided into-mechanicalvibration energy absorption in tissue-- and-frictional rubbing heatdevelopment in tissue-both of which result in a localized heating of thewalls of the blood vessel to obtain the-tissue closure. The performingof surgical procedures as related to this aspect of the invention isdiscussed with reference to FIGS. 2 through 9, inclusive.

In contrast to this we have the joining of layers of tissue inoverlapping relation to each other and in which case the compressive andvibrational forces are applied to one of the overlapped surfaces in aplanesubstantially normal thereto and in which case we primarily relyon-mechanical vibration energy absorption in tissue-to obtain the tissuejoining. The performing of surgical procedures as related to this aspectof the invention is discussed with reference to FIGS. 10 through 12D,inclusive.

Referring again to the drawings, and with respect to FIG. 2, it will beseen that an apparatus 10 for ultrasonically performing surgicalprocedures on a biological organism, such as a human, may include anultrasonic transducer or motor 11 for effecting the necessaryhigh-frequency vibrations of the tool member 13, such as a knife, havinga sharp output edge or surface 15 with a working surface 16. Theultrasonic motor 11, as illustrated may be in the form of a drivingmember adapted for being hand held as by an operator l2, and generallycomprising a tubular housing or casing 14 into which an insert unit 17supporting the tool member 13 may be partially telescoped. Theultrasonic motor 11 is energized by an oscillation generator 18, with apower cable 19, connecting the two together. The generator is anoscillator adapted to produce electrical energy having an ultrasonicfrequency.

The ultrasonic motor 11 may be one of a variety of electromechanicaltypes, such as electrodynamic, piesoelectric and magnetostrictive. Theultrasonic motor for effecting surgical procedures through hand directedtools of suitable configuration, which are readily replaceable orinterchangeable with other work performing tools in acousticallyvibrated material treating devices, may be of the type disclosed in U.S.Pat. No. Re. 25,033, 3,075,288, 3,076,904 and 3,213,537, and whereineach work tool member is rigidly joined, in endto-end relationship to aconnecting body or acoustic impedance transformer and to a transducerwhich may form an insert unit or assembly which is removably supportedin a housing containing a coil in surrounding relationship to thetransducer and receiving alternating current for producing analternating electromagnetic field.

The transducer in the ultrasonic motor ll is longitudinally dimensionedso as to have lengths which are whole multiples of half-wavelengths ofthe compressional waves established therein at the frequency of thebiassed alternating current supplied so that longitudinal loops ofmotion as indicated by arrow 23, occur both at the end of the insertunit 17 to which the tool member 13 is rigidly connected and the knifeedge. Thus, the optimum amplitude of longitudinal vibration andhyperaccelerations of tool member 13 is achieved, and such amplitude isdetermined by the relationship of the masses of the tool member 13 andinsert unit 17 which may be made effective to either magnify or reducethe amplitude of the vibrations received from the transducer.

The tool member 13 may be in the form of relatively flat metal spatulamember, as shown in FIGS. 8 and 8A,.

end of insert unit 17, for example, by brazing, solder or the like, orthe tool may be provided with a tW adapted to be screwed into a tappedhole in the end of insert unit 17 for effecting the rigid connection ofthe tool to the stem. A base portion 2] is provided from which the stud20 extends, from one end thereof, and from the other end a body 28 whichis firmly secured thereto for the transmission of the ultrasonicvibrations. The body 28 may be brazed or welded to the base 21 of thetool member 13. A tapered surface 22 may be provided which connects thecutting edge with the working surface I6.

As seen somewhat schematically in FIG. 2 the biological organism 25,such as a human, contains a layer of outer tissue or skin 26, aninternal cellular structure 27 with a plurality of blood vessels 30extending therethrough shown in an enlarged scale, as well as in theskin (not shown).

FIGS. 3, 3A and 3B illustrate various types of replaceable surgicalimplements, such as knives, that may be employed in accordance with thepresent invention. The knife 13a of FIG. 3 is similar to thatillustrated in FIG. 2 and includes a base portion 21a, capable ofsupporting ultrasonic vibrations and adapted to be set into vibration ina given direction by the driving member. A threaded stud 200 extendsfrom one end of the base 21a for engagement with the insert unit. Thebody portion 280, in the form of a cutting blade, extends from theopposite end of the base 21a and includes a textured working surface 16afor enhancing the coupling action between the tool member [3a and theterminal portion of the severed blood vessels to be engaged. The cuttingedge 150 may be serrated and have an outwardly tapered portion 22abetween the cutting edge 15a and the substantially flat working surface16a. The textured surface 16a may begin in close proximity to or startat the working edge 15a so that when cutting and sealing smallcapillaries the rubbing action and transmission of shear waves beginsimmediately. The textured surface finish of 16a may vary from a microfinish in the range of IO microinch to I0,000 microinch, but preferablyin the range of 40 microinch to 200 microinch.

As illustrated in FIG. 3A the tool member 130 includes a body portion280 having a coated textured layer of friction inducing material 29awhich forms the working surface 16a and which may be of diamond or steelpowder particles bonded to the body portion in any conventional mannerwell known in the art, to obtain the desired micro finish. The layer ofcoated material may be applied to both surfaces of the tool member andeach surface may be of the same or different microfinish to obtain adebriding and superficial cauterizing. The advantages are quickerhealing as well as less damage to the tissue being treated.

FIG. 38 illustrates the obtainment of the working surface 16a byfinishing the metallic body 280 in any conventional manner to obtain thedesired surface roughness. By providing the textured surface it ispossible to control the rate of frictional heating of the blood vessels.The surface roughness is generally selected in accordance with theultrasonic rate of vibration and the compressive force to be applied.This will in many instances relate to the particular surgeon performingthe operation.

THEORY OF PRESENT INVENTION Whereas a scientific explanation of thetheory based on the phenomena involved is disclosed below, it is to beclearly understood that the invention is by no means limited by any suchscientific explanation.

Applicant has now discovered thatmechanical vibrations properly appliedmay produce closures at the terminal ends of blood vessels to preventthe fiow of blood therefrom and also join together layers of humantissue. With respect to forming the terminal closure it is possible tosimultaneously cut through layers of tissue and seal off the terminalends.

For purposes of illustration, we have in FIGS. 4 and 4A a single bloodvessel 30b having a wall 31b with a terminal portion 33b terminating inan end surface 3217, the latter in engagement with the working surface16b of the tool member 13b which is being ultrasonically vibrated in thedirection 23b.

At the interface of the working surface 16b and terminal surface 32b wehave a transmission of both rubbing forces and mechanical vibrationalenergy to the blood vessel 30b which results in a localized heating ofthe terminal portion 33b. FIG.

4A illustrates the contour of the surfaces in engagement with each otherand the transmission of the shear waves over the distance D. Thepressure applied with the tool member, partially determines the degreeof shear waves and rubbing vibrations transmitted 'to the terminalportion 33b of the blood vessel for a given textured tool. At point P,shear vibration is developed in the tissue 310, then at P, the shearvibration has dropped almost to zero whereby the shear vibration energyis converted into heat in the tissue of the blood vessel. The smallnessor minimal depth of penetration of P,, P, is what makes for quickhealing and cauterizing action of the tool member.

The shear wave pattern 35b extends the distance D, which is the distancefrom P to P along the blood vessel 30b to obtain the localized heatingof the terminal portion. The coupling action at the working surface 16band blood vessel 30b is enhanced by the application of the smallcompressive force. as indicated by arrow 36b, in a plane substantiallynormal to the plane defined by said tenninal end surface 321). At P inaddition, to the extent that shear vibration is not induced in thetissue, there will be a slippage and a frictional rubbing action whichwill also produce heat practically instantaneously at P,. It is acombination of these effects which create the closure at the terminalportion of the blood vessel.

It will be appreciated that the relative amounts of shear vibration andfrictional rubbing action will be determined or selected by themagnitude of the tool vibration and the tool surface in relation to thetissue surface. Many combinations are possible whereby either thefrictional or the shear components may be emphasized.

The extent that the rise in temperature occurs at the terminal portion33b of the blood vessel 30b is related to the rubbing vibrations appliedand this is related to the peak speed which is:

V peak 2-rrf A A peak amplitude f frequency V= peak velocity So that iff is raised, A is lowered and we can retain the same peak speed at allfrequencies. This is why the more rubs per second the higher thefrequency for the same output peak speed. Accordingly the workingsurface 16b of the tool member 13b may be surface finished forsufficient roughness to allow increased friction against the tissue.This is quite different from a standard knife or scalpel which haspolished sides.

The thickness of the tool member should also be held to a minimum so asto permit a more rapid local temperature rise which is attributable tothe shear production and absorption in the adjacent tissue and thetemperature rise due to rubbing of tissue surface, which involvesslippage between tool member and tissue surfaces. We can say that duringthe to and fro motion, neglecting the energy of cutting itself, when aknife is used we have:

Ultrasonic energy per stroke Ultrasonic shear energy produced per strokeFrictional rubbing energy per stroke.

Since, in both cases the energy absorbed goes into superficial heatingof tissue and cutting tool, we can estimate the effects by consideringall the energy to be frictional for ease of making approximatecalculations.

Assuming an average force of friction, F, we have the power dissipatedsuperficially at a tool tissue interface equal to:

S stroke F average friction force P= power Now V max. for a frequency of20 kc./s. and a stroke of 0.010 inch is approximately 50 fps. ThereforeP is approximately 15 watts, when F is between one-half and l pound.Since this power is dissipated in superficial supreficial region of thecutting, the heat capacity of the tissue and the tool are quite small.For example for a steel tool of dimension lX0.l25x

dredths of a gram. In such a case it is possible to obtain localtemperature rises of the order of hundreds of degrees centigradecentrigrade under the condition outlined above. This is -ample to stopooze."

Accordingly the frequency and amplitude of vibration of said tool memberis selected at a level wherein the transmitted shear waves aresubstantially maintained at the terminal portion 33b with onlysuperficial penetration and heating of the remainder of the blood vessel30b.

Accordingly, the frequency and amplitude of vibration is preferablyselected at a level to provide a peak velocity of at least feet persecond along the working surface 16b of the tool member 13b and moregenerally the general range of approximately 40 feet per second to 100feet per second.

FIG. 4B shows a portion of the biological organism 25b with an outerlayer of skin 26b and a plurality of blood vessels 30b extending throughthe cellular structure 27b and terminating against the working surface16b of the tool member 13b. The tool member l3b is being vibrated at anultrasonic rate in the direction of arrow 23b, which is in a planesubstantially parallel to the plane defined by the terminal end portions33b, to induce shear waves 35b, which penetrate the blood vessels 30band surrounding tissue structure 27b. The high-frequency vibration andamplitude of the tool member is selected to obtain only a superficialpenetration and resulting heating of the terminal portions 33b so thatthere is a minimum of damage to the underlying tissue area 3112 and allof the blood vessels are simultaneously closed off.

As illustrated in FIGS. 4C and 4D the terminal portion 33b has an endsurface 32b that defines a plane 37b that may vary in angularrelationship to the axis of the blood vessel 30b. In practice theangular engagement between the working surface 161: of the tool member[3b and the end surface 32b may not always be controlled during asurgical procedure since the blood vessels such as capillaries,veinules, veins, arterials and arteries extend in various directionsthroughout the body. The important consideration is that the ultrasoniclongitudinal mechanical vibrations, as indicated by arrow 23b, areapplied having a major component of vibration parallel to the terminalplane 37b and a component of compressive force, as indicated by arrow36b, in a plane substantially perpendicular to the terminal plane 37b.

FIGS. 5, 5A, 5B, 5C, 6, 6A, 7 an 7A illustrate the actual surgicalprocedure in vivo of obtaining a closure at the terminal portion of ablood vessel using the ultrasonic instrument illustrated in FIG. 2, or atool member illustrated in FIGS. 4, 4A and 4B. As explained with respectto the theory of the present invention in FIGS. 3, 3A, 3B, 3C and 3D thedegree of shear waves and frictional rubbing may be controlled so that apredominant reliance on one or the other is produced.

In FIGS. 5, 5A, 5B and 5C the terminal closure 40c is formed primarilyby producing a plastic flow of the wall of the blood vessel andcontaining the flow for a period of time sufficient to obtain ajoiningof the severed ends together. Initially the cutting edge c of the toolmember 130 is placed in engagement with the skin 26c of the body 250 andthe tool member [3c is ultrasonically vibrated and a small compressiveforce in the direction of arrow 360 is applied to obtain a cutting ofthe skin 26c and progressively sever the tissue by a continued movementof the cutting edge 150 through the cellular material 270 until the wall310 of the blood vessel 30c is engaged. The wall 310 for purposes ofdiscussion is considered as layers of tissue 42c and 43c, respectively.

As seen in FIG. 5A after the cutting edge 15c severs the tissue layer420 a certain amount of blood 44c flows from within the blood vessel 30cinto the opening 450 that has been formed. As the movement of theultrasonic instrument is continued downwardly we have the engagement ofthe working surface 16c with the terminal end portion 336 of the bloodvessel to apply a compressive force to the end surface to obtain alocalized heating of the terminal portion by the application of theultrasonic mechanical vibration. The relative movement is continued sothat the application of the mechanical vibrations are transmitted for aperiod of time sufficient for the localized heating to form the closure40c at the terminal portion 33c. In this manner the terminal portion 330is closed off by the formation of the closure 45c and the bloodcontained therein is prevented from escaping through the closure. Theclosure 45c is produced at least in part by the production of said shearwaves and their conversion into heat coupled with the localized heatingobtained by inducing frictional rubbing at the terminal portion 330. Theextent of each factor will vary with the texture of the working surfaceI6c and the degree of the compressive force applied by the workingsurface against the terminal portion.

FIG. 50 is an enlarged microscopic examination of the blood 44c and asillustrated the blood contains red corpuscles 46c, white corpuscles 47cand platelets 48c, the latter play an important role in the naturalclotting of blood by producing fibrin when exposed to air. This naturalclotting ability of blood is relied upon at least in part with respectto the formation of the closures illustrated in FIGS. 6, 6A, 7 and 7A.

FIGS. 6 and 6A illustrate the formation of the closure which issubstantially formed by clotting of the blood at the terminal position.The working surface 16d is placed in engagement with the layers of wall42d and 43d of the blood vessel 30d, which is of a size in the capillaryrange, with the blood 44d contained therein. The tool member 13dpreferably has a textured surface to permit air and most importantlyoxygen to be delivered past the layer of skin 26d to the terminalportion 33d of the blood vessel to obtain a clotting action. The toolmember 16d acts as an ultrasonic pump and stimulates the flow of air toworksite. As the air reaches the worksite we have the additional actionof the conversion of the ultrasonic mechanical vibrations to obtain alocalized heating by the conversion of the frictional motion into heatand the localized heating expediates the formation of the blood clot 50dwhich forms the closure 40d. Since the blood vessel is relatively smallin diameter we have the formation of the closure 40d that issubstantially formed by a clotting of the blood 44d therein. As seen inFIG. 6A the tool member is then removed leaving the opening of wound 45dand closures 40d fonned on each respective end of the severed bloodvessels.

FIGS. 7 and 7A illustrate the fonnation of a closure 40c bycross-sectional closing the layers 42c and 43e of the wall 3!: of theblood vessel 30c at the terminal portions 33c by the localized heatingand the remainder by forming a blood clot 50s of the blood 44c containedin the reduced area of the blood vessel. The ultrasonic tool member I3etransmits the mechanical vibration which produces a plastic flow of thewall 31a of said blood vessel which flow is continued for a period oftime to obtain a reduced cross-sectional area and during which sameperiod of time the localized heating assists in the formation of theblood clot 502 which together with the reduced area forms the closure40c to prevent the blood from escaping therefrom. The tool member isthen removed past the skin 26 leaving the opening 45c.

It is appreciated that the process although illustrated for a singleblood vessel can be occurring simultaneously on a plurality of bloodvessels. To increase the rate at which the closure is formed and reducehealing time the working surface of the tool member may be heated to atemperature level which is above room temperature, but below atemperature that would normally sear the terminal portion of the bloodvessel. The temperature of the tool may be heated in any conventionalmanner, as for example, in accordance with US. Pat. No. 3,321,558.

There are instances in surgical procedures where it is desirable to beable to stop bleeding independently of having previously cut the tissueof the body. As for example, in gunshot wounds and other accidents it isoften desirable to stop bleeding and accordingly spatulalike tools inaccordance with the present invention may be utilized.

FIGS. 8 and 8A illustrate one form of readily replaceable implement, inthe form of a spatulalike tool member l3f, having a body portion 28]with substantially flat parallel working surfaces 16f that have beentextured to a preselected micro finish to provide means for coupling theultrasonic vibrations to the terminal portions of the blood vessels. Thesurface finish is selected for the transmission of rubbing vibrationsand shear waves to obtain the localized heating. One end of the spatulabody portion 28f is fixedly secured to the base portion 21f, and thelatter has a threaded stud 20f for securement to the ultrasonic drivingmember. The base portion 21f is preferably of a metallic materialcapable of supporting ultrasonic vibrations and adapted to be set intovibration in a given direction at ultrasonic frequencies. The bodyportion 28f may be in the order of 0.010 to 0.160 inches thick and beconcave in configuration for strength reasons. It may also be designedto vibrate elliptically to permit intermittent separation of the toolmember and terminal portions to promote the flow of air to the terminalportions for clotting. The obtainment of elliptical vibration forvibratory elements is well known in the art, for example, as illustratedin US. Pat. No. 2,990,916 in which applicant is a coinventor thereof.

As illustrated in FIG. 9 the spatulalike tool member is illustrated forsurgical procedures in which it is desired to form closures at terminalends of blood vessels 30g separately from when the actual cutting isperformed. Accordingly the spatulalike tool 13g is inserted within theopening 45g of the body g such that the working surface 163 of the toolmember 13g applies a compressive force against the terminal portions 33gof the severed blood vessels. The compressive force is applied in thedirection of arrow 36g. The tool 13g is simultaneously vibrated, in adirection as indicated by arrow 23g, and at an ultrasonic rate totransmit mechanical vibrations to the terminal portion 33g of the bloodvessels to obtain a localized heating of at least some of the tenninalportion. The application of said compressive force and mechanicalvibrations are continued until a closure at the terminal portion isformed and the blood contained therein is prevented from escapingthrough the formed closure. The thickness of the spatula tool member 13gmay be narrower, as illustrated in FIG. 9, than the opening 453 in thebody, such that only one surface 163 engages the severed blood vessels.If desired the width of the spatula body 28 may be substantially equalto that ofthe body opening 45g so that both terminal ends 33g of arespective blood vessel g is closed during one insertion of the toolmember within the wound.

The localized heating to obtain the closures may be induced byfrictional rubbing at the terminal portion 333 of the blood vessel 30gso that the closure is produced at least in part by frictional heating.By providing a textured surface to the tool member 13g the rate offrictional heating may be controlled when combined with the otherfactors to produce the terminal closure. Depending upon the thickness ofthe spatula tool member either pure longitudinal vibration will beobtained or a flexural component of motion, as indicated by the arrow51g, so as to obtain elliptical vibrational motion along the workingsurface 16g. This permits intermittent disengagement between the wallsurface or terminal end of the blood vessel 33g and the working surface16g so that air and in turn oxygen may be continuously supplied to thework site to assist in the clotting of the blood.

FIGS. 10 and 11 illustrate one form 10h of the ultrasonic system forjoining together in vivo, overlapping layers of organic tissue. Thesystem includes a hand held instrument including an ultrasonic motorllh, which may be the type as discussed with reference to FIG. 2, andinclude a tool member 13h having an enlarged portion 53h terminating ina working surface 16h that extends in a plane substantially normal tothe direction of mechanical vibrations illustrated by the arrow 23h. Thebase 2111 of the tool member 13h is secured to the insert portion 17h.Support means 55h is provided to act as an anvil or clamp so that theoverlapped layers of tissue 42h and 43h of the wall 31h of the bloodvessel 30h may be compressed between the vibratory working surface and asupport surface.

The support means 55h includes a pair oflegs 56!: and 5711 respectively,secured together at their lower end by bands 58h and provided withgripping means in the form of individual lugs 59h that extend outwardlyfrom the upper end of the legs for engagement by the fingers of thesurgeon or operator 12h in a manner hereinafter described. The leg 57hhas a lower ex tension 60h that terminates in a support arm 61h atsubstantially right angle to the extension 60h, and is provided with asupport surface 62h in spaced relation to the working surface 16h ofthetool member 13h.

The legs 56h and 57h are in spaced relation to each other and may becontoured to conform to the cylindrical configuration of the ultrasonictransducer housing 14h. The generator l8h is connected to the transducerllh by means of cable 19/: in a conventional manner. As seen in FIG. 10the cable 1% may enter the ultrasonic motor llh from the side so as toleave the rear end 63h free for engagement by the thumb or any otherfinger of the surgeon to permit manual control of the relativedisplacement between the overlapping working and support surfaces.

The support means 55h is mounted for relative movement, with respect tothe ultrasonic motor llb by providing a pair of slots 65h on each of thelegs 56h and 57h, and which slots accept headed fasteners 66h whichextend from the casing 14h through the slots 65h to permit free relativemovement between the ultrasonic motor llh and support means 55h. Thelower end of the casing 14h is provided with an annular shoulder 67hwhich is adapted to receive spring means in the from of a spring 68hwhich is contained within the shoulder 67h at one end thereof and inengagement with the bands 58h at the opposite end thereof. The spring68h applies a force in the direction of arrow 68h, so that the workingsurfaces of the support means and ultrasonic motor means are biassedaway from each other whereby the force applied by the surgeon isrequired to bring the overlapping working and support surfaces together.lf desired the spring may be coupled to the support and ultrasonic motormeans so as to force them together with a predetermined static forcewhich might be varied in a conventional manner not shown. in this manneronce the static force is determined for the particular thickness oftissue the resultant permanent or temporary seal may be obtained.Accordingly the spring means may yieldably urge the support means 55hand transducer means llh relative to each other to a position whereinthe working and support surfaces l6h and 62h, respectively, are normallyin engagement with each other under a predetermined static force, sothat the support and transducer means are first separated for theplacement of the layers of tissue 42h and 43h therebetween. In contrastto this the spring means may be adjusted such that the working andsupport surfaces are normally maintained in spacially fixed relation toeach other, so that the layers 42): and 43h are positioned between thesurfaces which are brought together by the operation of the hand heldinstrument.

As previously explained during surgical procedures it becomes necessaryto tie-off veins and arteries so as to prevent the flow of bloodtherethrough. In accordance with the invention thejoining of the wallsmay be ofa permanent or semipermanent nature, and this is accomplishedby properly selecting the frequency and amplitude of ultrasonicmechanical vibrations to produce an optimum flow of the collagenouselements contained in the overlapping portions of tissue. Thiscollagenous material is similar to that non'nally found in the formationof scar tissue. In practice the ultrasonic instrument 10h may beemployed tojoin together, at a select area the wall of a blood vesseland as seen in FIG. 10 the wall 31h may be considered to include theoverlapping layers of tissue 42h and 43h.

As seen in FIGS. l2, 12A and 128 we have the blood vessel 30h exposedwithin an opening 45h within the organic body 25h. To produce ajoiningof the overlapping layers of wall tissue 42h and 43h respectively, thearm 61h of the support means 55h is placed beneath the blood vessel 30hand the working surface 16h of the tool member 13h is brought intocontact with the layer of tissue 42):. The working and support surfaces16h and 62h are moved relative toward each other until the blood vessel30h has the overlapping layers of tissue 42!: and 43!: in contact witheach other as seen in FIG. 12A. Simultaneously therewith a smallcompressive force, in the direction of arrow 36h, is applied to thelayers of tissue traversing the area of overlap.

The working surface of the tool member 13!: is vibrated at an ultrasonicrate, as for example, in the frequency range of from l kc./s. to l00kc./s. and preferably in the range of kc./s. to 40 kc./s., so as toapply an additional recurring force to the overlapped layers of tissue,and produce a superficial heating at the interface of the overlappedlayers. The vibrational force has a substantial component of vibrationnormal to the overlapped surfaces, as indicated by the arrow 23h. Thefrequency of the ultrasonic rate of vibration is selected in the abovefrequency range so as to preferably also produce an optimum flow of thecollagenous elements in the overlapped layers of tissue. The energy isthen continually applied until a closure or bond 40h is formed betweenthe collagenous elements in the overlapping layers of tissue, as seen inFIG. 12B, and the blood is prevented from flowing past the closure. Theclosure 40!! may be of a temporary nature or permanent one dependingupon the proper control of the vibratory energy and static force to fusetogether the superficially heated interface.

For certain applications it is desirable to join together theoverlapping layers of tissue and at the same time cut off the excessmaterial. As illustrated in FIG. 12C the support arm 61] is providedwith a cutting edge 70j and as the overlapped layers of tissue 42] and43] are compressed between the working surface l6j and support surfacel6j and joined together by the energy transmitted through the toolmember l3j and the excess tissue layers 7lj and 72j are cut off. Ifdesired the cutting edge may be placed on the working surface l6j of thetool member 13].

For those applications in which it is desired to intermittently jointogether overlapping layers of tissue we have the apparatus illustratedin FIG. l2D..The overlapping layers of tissue 42k and 43k are firstclamped together by clamping means 75k which includes clamping members76k and 77k which may form part of the ultrasonic instrument or may bethe forward portion of a pair specially designed clamping instrument.The clamping means 75k is applied in close proximity to the area ofoverlap of the layers of tissue 42k and 43k to be joined together. Theultrasonic instrument 10k includes the support means 55k for engagingone side of the overlapped layers of tissue and which opposite side isengaged by the tool member 13k which as illustrated is provided with acircular working surface. By intermittently moving the ultrasonicinstrument along the area of overlap a number of closures or bonds 30k,such as stitches may be formed.

While the invention has been described in connection with particularultrasonic motor and tool member constructions, various other devicesand methods of practicing the invention will occur to those skilled inthe art. Therefore, it is not desired that the invention be limited tothe specific details illustrated and described and it is intended by theappended claims to cover all modifications which fall within the spiritand scope of the invention.

lclaim:

l. A method of superfically cauterizing a wound at the terminal portionof severed blood vessels in vivo, with a noncutting spatulalike toolmember having a working surface, comprising the steps of A. applying theworking surface of said tool member in engagement with the terminalportion of said blood vessels, said tool member being at substantiallyroom temperature,

B. retaining said tool member in a position relative to said severedblood vessel,

C. maintaining a compressive force against said terminal portion in aplane substantially normal to said engaged surface with said noncuttingspatula like tool member,

D. vibrating the working surface of said tool member at a peak velocityof at least l0 feet per second and simultaneously with the maintainingof said compressive force to apply ultrasonic mechanical rubbingvibrations substantially parallel to the terminal portion of said bloodvessels in a direction so as to apply an additional energy produc: ingforce to obtain a localized heating of the terminal portion, thedirection of said mechanical vibrations being applied to produce shearwaves at the terminal portion of said blood vessels, and said bloodvessels, and said localized heating of the blood vessels is obtained bythe conversion of said shear waves to heat, whereby said superficalcauterization is produced at least in part by the production of saidshear waves, and

continuing the retaining of said tool member in a position relative tosaid severed blood vessels and the application of said mechanicalrubbing vibrations for a period of time sufficient for said localizedheating to form a superfical cauterization at the terminal portion.whereby the terminal portion is closed oh and the blood containedtherein is prevented from escaping.

2. A method as claimed in claim 1 wherein said localized heating is alsoobtained by simultaneously inducing frictional rubbing at said terminalportion of said blood vessel by the application of said mechanicalvibrations, whereby said cauterization is produced at least in part bysaid frictional heating.

3. A method as claimed in claim 1, wherein said blood vessel isrelatively small in diameter and said cauterization is substantiallyformed by clotting of the blood at said terminal portion thereof.

4. A method as claimed in claim 1, wherein said cauterization is atleast in part formed by a blood clot, and said localized heatingexpedites the formation of said blood clot.

5. A method as claimed in claim 1, wherein said cauterization is formedby partially closing the blood vessel by said localized heating and theremainder by clotting the blood contained in said reduced area of theblood vessel.

6. A method as claimed in claim I, wherein said mechanical vibrationproduces a plastic flow of the wall of said blood vessel and said flowis continued for a period of time sufficient to obtain a joining of thewall of said blood vessel to from said closure.

7. A method as claimed in claim I, wherein said blood vessel is acapillary.

8. A method as claimed in claim I, wherein said blood vessel is anarterial.

9. A method as claimed in claim I, wherein said blood vessel is aveinule.

10. A method as claimed in claim 1, wherein said blood vessel is anartery.

ll. A method as claimed in claim 1, wherein said blood vessel is a vein.

12. A method as claimed in claim 1, wherein said ultrasonic mechanicalvibrations are applied over and area to. simultaneously close off aplurality of blood vessels.

13. A method of superfically cauterizing severed blood vessels of awound in vivo, with the aid of a noncutting spatula like tool memberhaving a working surface, comprising the steps of A. applying theworking surface of said tool member against the terminal portion of saidblood vessels, said tool member being at substantially room temperature,

B. retaining said tool member in a position relative to said severedblood vessels,

C. maintaining a compressive force applied along a line substantiallyperpendicular to the plane defined by the terminal portion of said bloodvessels with said noncutting spatula like tool member,

D. simultaneously vibrating the working surface of said tool member, ata peak velocity of at least 10 feet per second and, while maintainingsaid compressive force, in a direction and at an ultrasonic rate totransmit mechanical vibrations to the terminal portion, said localizedheating is obtained by inducing friction rubbing at the terminal portionof said blood vessels by the application of said mechanical vibrations,and

E. continuing the retaining of said tool member in a position relativeto said severed blood vessels and the application of said compressiveforce and mechanical vibrations until a superfical cauterization at saidterminal portion is formed, whereby the blood contained therein isprevented from escaping.

14. A method as claimed in claim 12, further including the step ofcontrolling the rate of frictional heating of the terminal portion ofsaid blood vessel.

15. A method as claimed in claim 14, wherein said rate of frictionalheating is controlled by texturing said toolworking surface to a surfaceroughness selected in accordance with the ultrasonic rate of vibrationand compressive force to be applied.

16. A method as claimed in claim 13, wherein the application of saidmechanical vibrations also simultaneously produce at least in part shearwaves at said terminal portion, and the frequency and amplitude ofvibration of said tool member is selected at a level wherein saidtransmitted shear waves are substantially maintained at the terminalportion with only superficial penetration and heating of the remainderof said blood vessel.

17. A method as claimed in claim 13, wherein said peak velocity is inthe range of approximately 40 feet per second to i [00 feet per second.

1. A method of superfically cauterizing a wound at the terminal portionof severed blood vessels in vivo, with a noncutting spatulalike toolmember having a working surface, comprising the steps of A. applying theworking surface of said tool member in engagement with the terminalportion of said blood vessels, said tool member being at substantiallyroom temperature, B. retaining said tool member in a position relativeto said severed blood vessel, C. maintaining a compressive force againstsaid terminal portion in a plane substantially normal to said engagedsurface with said noncutting spatula like tool member, D. vibrating theworking surface of said tool member at a peak velocity of at least 10feet per second and simultaneously with the maintaining of saidcompressive force to apply ultrasonic mechanical rubbing vibrationssubstantially parallel to the terminal portion of said blood vessels ina direction so as to apply an additional energy producing force toobtain a localized heating of the terminal portion, the direction ofsaid mechanical vibrations being applied to produce shear waves at theterminal portion of said blood vessels, and said blood vessels, and saidlocalized heating of the blood vessels is obtained by the conversion ofsaid shear waves into heat, whereby said superfical cauterization isproduced at least in part by the production of said shear waves, and E.continuing the retaining of said tool member in a position relative tosaid severed blood vessels and the application of said mechanicalrubbing vibrations for a period of time sufficient for said localizedheating to form a superfical cauterization at the terminal portion,whereby the terminal portion is closed off and the blood containedtherein is prevented from escaping.
 2. A method as claimed in claim 1,wherein said localized heating is also obtained by simultaneouslyinducing frictional rubbing at said terminal portion of said bloodvessel by the application of said mechanical vibrations, whereby saidcauterization is produced at least in part by said frictional heating.3. A method as claimed in claim 1, wherein said blood vessel isrelatively small in diameter and said cauterization is substantiallyformed by clotting of the blood at said terminal portion thereof.
 4. Amethod as claimed in claim 1, wherein said cauterization is at least inpart formed by a blood clot, and said localized heating expedites theformation of said blood clot.
 5. A method as claimed in claim 1, whereinsaid cauterization is formed by partially closing the blood vessel bysaid localized heating and the remainder by clotting thE blood containedin said reduced area of the blood vessel.
 6. A method as claimed inclaim 1, wherein said mechanical vibration produces a plastic flow ofthe wall of said blood vessel and said flow is continued for a period oftime sufficient to obtain a joining of the wall of said blood vessel toform said closure.
 7. A method as claimed in claim 1, wherein said bloodvessel is a capillary.
 8. A method as claimed in claim 1, wherein saidblood vessel is an arterial.
 9. A method as claimed in claim 1, whereinsaid blood vessel is a veinule.
 10. A method as claimed in claim 1,wherein said blood vessel is an artery.
 11. A method as claimed in claim1, wherein said blood vessel is a vein.
 12. A method as claimed in claim1, wherein said ultrasonic mechanical vibrations are applied over andarea to simultaneously close off a plurality of blood vessels.
 13. Amethod of superfically cauterizing severed blood vessels of a wound invivo, with the aid of a noncutting spatula like tool member having aworking surface, comprising the steps of A. applying the working surfaceof said tool member against the terminal portion of said blood vessels,said tool member being at substantially room temperature, B. retainingsaid tool member in a position relative to said severed blood vessels,C. maintaining a compressive force applied along a line substantiallyperpendicular to the plane defined by the terminal portion of said bloodvessels with said noncutting spatula like tool member, D. simultaneouslyvibrating the working surface of said tool member, at a peak velocity ofat least 10 feet per second and, while maintaining said compressiveforce, in a direction and at an ultrasonic rate to transmit mechanicalvibrations to the terminal portion, said localized heating is obtainedby inducing friction rubbing at the terminal portion of said bloodvessels by the application of said mechanical vibrations, and E.continuing the retaining of said tool member in a position relative tosaid severed blood vessels and the application of said compressive forceand mechanical vibrations until a superfical cauterization at saidterminal portion is formed, whereby the blood contained therein isprevented from escaping.
 14. A method as claimed in claim 13, furtherincluding the step of controlling the rate of frictional heating of theterminal portion of said blood vessel.
 15. A method as claimed in claim14, wherein said rate of frictional heating is controlled by texturingsaid toolworking surface to a surface roughness selected in accordancewith the ultrasonic rate of vibration and compressive force to beapplied.
 16. A method as claimed in claim 13, wherein the application ofsaid mechanical vibrations also simultaneously produce at least in partshear waves at said terminal portion, and the frequency and amplitude ofvibration of said tool member is selected at a level wherein saidtransmitted shear waves are substantially maintained at the terminalportion with only superficial penetration and heating of the remainderof said blood vessel.
 17. A method as claimed in claim 13, wherein saidpeak velocity is in the range of approximately 40 feet per second to 100feet per second.
 18. A method as claimed in claim 13, wherein saidworking surface is vibrated in an elliptical pattern.
 19. A method asclaimed in claim 13, wherein said mechanical vibrations are produced byvibrating the tool member to obtain longitudinal vibrations along saidworking surface, which working surface is maintained along a planesubstantially parallel to the plane defined by the terminal portion ofsaid blood vessel.
 20. A method as claimed in claim 13, wherein saidtool working surface is of sufficient area to simultaneously cauterizerespective terminal portions.